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Haematological and general symptoms include: Persistent fatigue or weakness disproportionate to weight loss Shortness of breath on minimal exertion Palpitations or rapid heart rate Pale or jaundiced appearance Glossitis (sore, red tongue) or mouth ulcers Unexplained decline in appetite (beyond expected GLP-1/GIP effects) Urgent medical attention is required for: New or progressive neurological deficits Ataxia (problems with coordination and balance) Visual changes Severe anaemia or cardiovascular symptoms Any B12 deficiency symptoms during pregnancy Patients should contact their GP if they experience: New or worsening neurological symptoms, particularly sensory changes Persistent extreme fatigue affecting daily activities Unexplained cognitive changes or memory problems Symptoms of anaemia It is important to note that B12 deficiency can exist without obvious symptoms , particularly in early stages

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And liability does not stop with the prescribing physician

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Most patients report that these initial side effects become less intense with repeated doses, a pattern called tachyphylaxis, where your nervous system adapts to the drug's presence